Provider Demographics
NPI:1538309984
Name:PETRY, JENA LYNETTE (RN, MSN,NNP)
Entity Type:Individual
Prefix:MRS
First Name:JENA
Middle Name:LYNETTE
Last Name:PETRY
Suffix:
Gender:F
Credentials:RN, MSN,NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 LOMA HERMOSA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3706
Mailing Address - Country:US
Mailing Address - Phone:915-821-6119
Mailing Address - Fax:
Practice Address - Street 1:1900 N OREGON ST
Practice Address - Street 2:SUITE 601
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3351
Practice Address - Country:US
Practice Address - Phone:915-542-0755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX551745363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal